Thursday, January 31, 2008

Monday was the twentieth anniversary of the death of newFNP's mom. NewFNP is not old enough to have passed this anniversary, but it came and went nonetheless. NewFNP was feeling pretty sad about it and had a heartbreaking conversation with her younger brother in which mom's favorite flavor of ice cream was hypothesized about, but remained unidentified. It seems more significant when the person is gone.

Well, nothing takes the sting out of that miserable piece of crap day than to get an e-mail noting that one will be working every frigging Saturday in February. NewFNP feels compelled to remind everyone that Saturday clinic now begins at a soul-crushing 7:30 AM. NewFNP promptly replied to this e-mail assault, employing words such as 'unacceptable' and 'disheartening' and 'go fuck yourself.' OK, that last one was not verbatim but newFNP likes to think that she conveyed the sentiment in a very genteel fashion.

NewFNP's COO earnestly apologized and promised that he would change her schedule and that she would be working only two Saturdays, as per newFNP's agreement.

At three o'clock today and after seeing 20-something patients, newFNP received an e-mail reflecting the change. Lo and behold, newFNP had a paltry one Saturday off and, friends, it was not the one she had specifically requested. She attempted to broach the topic with her COO, but he was late for a meeting.

So newFNP left her patients in her exam rooms, donned her Tom Ford sunglasses and walked out, frustrated and feeling powerless.

Granted, she only walked around the block, but she could have kept on walkin' if not for the risk of bodily harm via drive by shooting and of credit harm via student loan default.

But instead, she went back, did a couple of exams and then solved the problem.

The huge drag is that it didn't even need to be a problem. Dr. Dual-Ivy-League-Degrees offered to work one of newFNP's Saturdays. The Real Dr. Mc Dreamy is working part time and she offered to pick up another Saturday. All that really needed to occur was a little communication.

NewFNP is certain that poor communication is a problem in many community health clinics. But newFNP is sick of it. She is committed to community health, she is willing to be flexible, she has no intention of leaving. Is senior management trying to force her out?

Community health clinics have a hard enough time keeping providers. NewFNP doesn't need a clothing allowance, but she does need to be treated with courtesy.

Tuesday, January 29, 2008

NewFNP is here to help readers in all pursuits to the best of her ability, not just in medicine but in general well-being as well.

As many of us in the health professions know, the perfect footwear can be elusive indeed. Many of us opt for the Dansko clog, an ever popular and respectable choice. Orthopedically sound and very European in sensibility.

NewFNP, however, does not opt for said clogs. Dansko clogs were all she saw during her years in nursing school. Danskos and knitting needles. NewFNP's fellow students were practically wearing down the sturdy Dansko soles while hauling fucking looms to class to make furry, multi-colored scarves. Anyway, newFNP did try the Dansko clogs but she was always feeling precariously balanced in the ankle department, not to mention that they just didn't go with newFNP's overall aesthetic.

Enter the Sigerson flat. OK, to be fair, the Sigerson Belle flat -- newFNP is not made of money after all. The problem with the Sigerson flat is that they are truly frigging flat. They are so flat that one may as well tape a piece of cardboard to one's soles and fashion a cute printed upper with some wrapping paper from Paper Source. Cute as hell though they may be, that amount of flat is no good.

So what is a fashion conscious newFNP to do?

Enter the melange of Cole Haan and Nike. NewFNP would have never thought herself one to tout the benefits of Cole Haan but, oh, that heavenly marriage. If it weren't for the high price-point, newFNP would buy out the stock of Nike Air-soled G Series ballet flats. NewFNP, after all, is nothing if not an OG. And OG's need cute and comfortable ballet flats in pewter leather with satin trim or in red perforated suede with a little sweet white patent leather trim.

NewFNP is a committed sale-shopper and recommends buying said exquisite ballet flats on sale as comfort doesn't come cheap from ole Cole Haan.

Thursday, January 24, 2008

NewFNP's clinic has had a spike in the incidence of STD's lately. Since Cocoa Brown, two more patients have tested positive for syphilis. Neither of them were Ms. Brown's abused partner. Another patient's downstairs was so disturbing in the olfactory sense that newFNP was quite sure that an animal had crawled up there, homesteaded her vagina and died.

And, finally, newFNP has been burned by chlamydia twice recently. Thankfully, the burn has only occurred in her professional life!

Chlamydia is supposed to be asymptomatic at best and have a mild discharge at worst. It is not supposed to mimic gonorrhea and have purulent discharge and a traumatizing odor. NewFNP fully acknowledges that she is at fault here in that she should have treated the patient for chlamydia when she erroneously treated the gonorrhea. But the discharge, people, the discharge. Who could have thought that little ole chlamydia would cause such a thing?!?

It sucks to have failed public health to re-learn the lesson that you treat for chlamydia when you treat for gonorrhea. But here newFNP is, kicking herself for missing the Chlam.

Let this be a lesson to you, newFNP readers. Be liberal with your STD antibiotics.

Sunday, January 20, 2008

NewFNP generally does not have cable, but has something called "antenna service" through her local rip-off cable company. Otherwise, she could not watch any TV at all, not even The Office or How I Met Your Mother and that is just not realistic. But every once in a while, her rip-off cable company graces her with basic cable. She never knows how long it will last, but she has enjoyed fully four hours of a frustratingly glorious program: What Not To Wear.

NewFNP would kill to get on a program that gave her five grand to go on a shopping spree in SoHo. Plus free hair-do and a little make up advice? Please. And these ladies get all pissy about having the opportunity to throw away their Kohl's and softer side of Sears wardrobes! Puh-leez!! Say goodbye to the puffy paint sweatshirt and Christmas cardigan and hello to Olive & Bettes and Bloomies on Broadway.

NewFNP would be such a better NP if she had five thousand dollars worth of free clothes. She would even promise to read peer-reviewed journals on the subway rides between boutiques!

Dare to dream, newFNP. Dare to dream.

Dream is just what newFNP will do on her day off tomorrow. Dream a little dream of fashion.

Thursday, January 17, 2008

NewFNP was a huge fan of the Pirates of the Caribbean movie. Not the one where the guy played the organ with his face tentacles and Johnny Depp was swallowed by a giant vagina, but the first in the trilogy in which a swashbuckling Johnny Depp was swarthy and sexy with his pirate eyeliner and his pirate shirt and his pirate vernacular. NewFNP, however, did not adopt the pirate fashion and make it her own.

Apparently, however, the new nutritionist at newFNP's clinic was so moved by pirate couture that she has incorporated it into her daily wardrobe.

When newFNP starts a new job, she wears some sensible yet flattering trousers and a cashmere sweater with some low heels or flats her first day. She's not all pearls and Lilly Pulitzer, but she tries to put together something smart.

What she does not wear is a wide teal stretchy headband with a high, loose, devil-may-care ponytail, a black sweater, teal herringbone trouser shorts and black lace-up knee high high-heeled boots. That is exactly what the new nutritionist was sporting during her meet and greet. She must have left her parrot and eye patch in the car.

NewFNP wonders how she will do her nutrition education. Will she be all: Arrrr! Me bonny lass - eat ye veggies or ye shall walk the plank. Will she advocate for Pirate's Booty over Hot Cheetos and, if so, is she part of some pirate mafia that gets a kick-back?

NewFNP is actually quite thankful to have the pirate nutritionist on board. Since the recent departure of our gaudily-dressed dentist, newFNP's clinic has been woefully lacking in fashion mishaps such as the camel toe and work no-no's such as the low-cut blouse/Wonderbra combo.

Friday, January 11, 2008

NewFNP loves her Fridays off. A little hiking, a little Bloomingdales sale to spend birthday 2006's gift certificate, a little Cosby Show rerun*. OK, that part is not so great but newFNP is one of the few remaining people who do not have cable so she is willing to indulge in a little retro-TV for a half hour.

She has spent a fair amount of her free time today, however, wondering what happened with a kid she sent to the ED on Wednesday.

NewFNP is generally so overwhelmed with type 2 diabetics that she had almost forgotten that type 1 diabetes existed as well. She even expects to diagnose her pediatric patients with type 2, given the degree to which she encounters the consumption of Hot Cheetos, Gatorade, and whole milk in her patients, as well as the prevalence with which she notes acanthosisnigricans, abdominal striae and hidden penises on physical exam.

However, newFNP would be remiss if she forgot that those wacky type 2 patients account for only 90% of diabetes diagnoses. She is fairly sure that she caught a kid in the early stages of Type 1 this week.

What a lousy 10% to be a part of!

This normal weight twelve year old boy -- whose well-child visit and urine dip were unremarkable a mere six months earlier -- came to our clinic with the chief complaint of abdominal pain. NewFNP's list of differentials includes things like appendicitis, AGE, UTI, nephrolithiasis and post-Winter Break school avoidance. As a general screening tool, newFNP has impressed upon her MA the importance of obtaining a urine dip on all of her tummy ache complaints and her MA never fails her in regards to this task.

Well, imagine newFNP's surprise when this kid's urine was chock-a-block full of glucose and ketones! When newFNP checked his fingerstick glucose, it was 313 and this was not a kid who had fed at the fast food trough prior to his visit. He had lost 3 pounds since his last well-child visit. He didn't look bad, just a little tired. He didn't smell ketotic and his breathing was normal.

NewFNP hasn't seen type 1 diabetes since she was working as an RN in her training hospital. She hasn't diagnosed it before and she was not sure if this kid's abdominal pain had anything to do with his diagnosis. Well, as it turns out, acute abdominal pain is a common presenting symptom of type 1 diabetes. Huh!

NewFNP's clinic has nothing - no RN's, no health educators, no nothing. Therefore, some quick education with the kid and parent about newFNP diagnostic suspicions and off to the ED. NewFNP is hopeful that the patient will bring back such important paperwork as c-peptide test results, discharge instructions and the name of his endocrinologist.

And if he comes back in tomorrow, newFNP will be waiting there for him at seven-fucking-thirty. She will make every effort to be pleasant, but it does, frankly, seem a stretch.

* In this episode, Rudy gets sent home by the school nurse when she gets her first period and Claire wants to have something called "Woman's Day" with her. Apparantly, Lisa Bonet and the other daughter - Vanessa, if memory serves - both had Woman's Days and Vanessa's involved a trip to the Plaza Hotel for brunch. NewFNP went to the Plaza to celebrate her her 30th birthday, not her frigging menarche, a day which she still curses! Those crazy Huxtables!

Tuesday, January 08, 2008

Long before newFNP was newFNP, she worked at a little county health department in the city where she completed her undergraduate studies. One patron of the health department was a fellow who had his face tattooed. He didn't have anything specific, just a lot of black ink obscuring his face. The effect screamed both "mental illness" and "don't talk to me - I am dangerous." Perhaps this was like a warning to would-be interlopers. It worked on newFNP; she never talked to the dude.

NewFNP has seen her fair share of hideous tattoos at her clinic. Bad butterflies, homages to dead loved ones, gang affiliations and plenty of crosses and dots in the web of the hand between the index finger and thumb which newFNP presumes to indicate gang membership or a history of incarceration.

However, there are some tattoos that just burn an indelible image in one's mind. Could anyone forget the image of the masturbating lady proudly displayed on the leg of one of newFNP's young patients? His mother must have been so proud. Imagine newFNP's surprise when a second patient had a strikingly similar tattoo! She had no idea there was such a market for these forays into the repulsive and permanent.

Well, Dr. Dual-Ivy-League-Degrees had a patient today who may have held the gold medal in repulsive tattoos. Apparently, this chap had a lady - naked, of course - tattooed on his abdomen, legs spread widely and intersecting at his umbilicus thereby allowing his belly button to form her anus. Classy and thoughtful! It must take a real talent to envision the design and then make it come to fruition without giving the lady one leg shorter than the other or some other such defect. Good thing the guy didn't have an outie! That would just be gross.

NewFNP presumes that these guys are straight as she knows no gay men who objectify women in this way. But what newFNP can't quite wrap her mind around is who exactly are the women who have sex with these guys? How low can one's self esteem get?

It is rare that newFNP sees women with such patently offensive tattoos, but she does recall one woman with a tattooed necklace that reads "Fuck niggaz and money" in two-inch script. More sad than offensive, really - at least in newFNP's eyes. NewFNP wonders who has screwed over this woman so incredibly that she thought to permanently emblazon her chest with this statement. Any newFNP doesn't quite understand the 'money' part. Apparently, this woman does not have six-figure student loan debt to repay.

And a final question: who does these tattoos? Perhaps they could do us all a favor and be trash collectors or dog catchers or captains of industry, huh?

Friday, January 04, 2008

If newFNP didn't have photographic documentation of herself salsa dancing and Corona-drinking in a far-far-away city a mere five evenings ago, she would swear that she had been trapped in her urban community health clinic Gulag for ages.

NewFNP wants to storm into the packed waiting room and scream: People! Let's band together and stop this nonsense! You have a cold? Go home! You have diabetes and ate a doughnut, a tamale and a double mocha frappuccino before your appointment? You're fired!

And those would be the easy cases. Today, newFNP's cases were not so.

Influenza? Check.

Child sexual abuse? Check.

Crying overweight ladies (plural) who don't want to have sex with their husbands? Check. (Prayer - please, please, please do not let newFNP ever fall into this group!!)

NewFNP is not a parent, but if she were, she is pretty sure that if her child had some inborn error of metabolism or some genetic defect, she would at the very least have the wherewithal to write down the name of the fucking thing on a sticky pad. This would hold true even if newFNP were not an FNP. If newFNP were a fancy nail salon girl or a go-go dancer or even a rodeo clown, she would know enough to learn the name of the condition. Even more so if she herself had undergone genetic testing and had some genetic-something or other, as her patient's mom had.

When one spends nine years in post-secondary education, one's bar for normal intelligence is so absurdly skewed. Friends, newFNP is living 'regression to the mean' and this lady was at least two standard deviations below! NewFNP thought that everyone was like herself and her super-education friends.

Wrong. Oh sweet Lord, how wrong she was.

NewFNP hates to just chalk it up to 'stupid,' but sometimes the shoe fits. Can newFNP write "Mom not so bright" in the progress note? It only seems fair to give the next provider fair warning.

Thursday, January 03, 2008

Outside of clinic, newFNP's life is going swimmingly. She's got some cute new sneakers and slimming workout pants, her romantic life is picking up and she bought a ceramic flat iron which effortlessly turns newFNP's curly mop from wild to sleek.

Clinically speaking, not so much. It's not that the patients are any more challenging or frustrating. No, it's that, starting this Saturday, newFNP's clinic is open from 7-fucking-o'clock until 3:30. Formerly, Saturdays were a merciful 8-to-2. This vicious change was announced in an e-mail this week. No opportunity for discussion, no mention of increased salary due to extended working hours. Just an 'Oh, by the way...'

Seven o'clock, people? Seven? Come on! NewFNP isn't even a wild party girl, spending all night in the club shaking her ass to reggaeton while downing Red Bull and vodka! All she wants is to enjoy a few glasses of PinotNoir on Friday night, maybe watch a movie or paint her toenails and then peacefully sleep until 6:30 and still make it to work on time.

NewFNP is none too pleased.

When in grad school, newFNP frequently saw students, whom she presumed to be undergrads, walking around campus in their PJs. Not even cute Juicy sweatpant-PJs, but Spongebob flannel pieces of crap. Can newFNP wear velour Juicy sweatpants to work on Saturdays? They're a hundred bucks, for Christ's sake. It seems a shame to only wear them at home.

Wednesday, January 02, 2008

It's always tough to return to work after Hanukkah, Christmas, newFNP's birthday and New Year's Eve. It's even tougher for newFNP when her plane lands thirty minutes late and she returns to her apartment at 12:30 AM and is so enthralled with her book that she just cannot put it down and then all of the sudden, it's 1:30 AM and newFNP utters "fuck" and switches off the light.

Seemingly, five minutes pass and newFNP awakens to the sweet sounds of NPR and again utters "fuck" and starts her day. Her day which ended 33 patients later.

Fuck 2008 so far. Thankfully, bad weather is in store so there will perhaps be a lull in the patient flow.

NewFNP is in the home stretch. Her service commitment ends this year and she will be a free agent. NewFNP, however, is a glutton for punishment and is eagerly awaiting the application for another two years of indentured servitude in order to pay off more loans. If only community health paid like professional sports, newFNP would not still be living in a one bedroom apartment and cursing her six-figure student loan debt.

Damned fancy schools with their Latin-inscribed degrees!

School debt and overworked days aside, newFNP is looking forward to yet another year of sharing stories. Truly, how could newFNP ever leave her ridiculous practice? Do stories like these exist in private practice??

This blog is for new NPs or NP students who want some real 411 on the life of a new practitioner. A new practitioner in a busy, understaffed, urban community health clinic in a major metropolitan area. Oh, and newFNP swears while writing and, sometimes, while working although she tries to keep those swears to herself. Consider yourself warned.